Long-Term Comparison of Immunosuppressive Therapy with Antithymocyte Globulin to Bone Marrow Transplantation in Aplastic Anemia
Treatment recommendations for aplastic anemia are based on long-term survival data for recipients of syngeneic or allogeneic bone marrow transplants (BMT) and the more recent results of “immunosuppressive therapy” (1ST), which usually includes antihuman thymocyte globulin (ATG) or antihuman lymphoblast globulin (ALG). Patient age and availability of a suitable marrow donor limit the number of patients who are potential candidates for marrow grafting. Many centers will not recommend an allogeneic BMT for patients with aplasia who are over 40 years of age, although some extend the upper age limit to 50 years. Suitable marrow donors include identical twins, genotypically HLA-identical siblings, or phenotypically HLA-identical family members. Transplants using HLA-mismatched family members or phenotypically identical, unrelated donors are usually reserved for “salvage” therapy after failure of a nontransplant treatment regimen.
KeywordsHuman Immunodeficiency Virus Aplastic Anemia Chronic GVHD Paroxysmal Nocturnal Hemoglobinuria Actuarial Survival
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